Chapter 450: Chapter 450: Winter-Warmth
The couple was very anxious.
They explained, "Dr. Li, our son was hospitalized for severe pneumonia yesterday. He’s been in the inpatient department. After a full day of treatment, his condition hasn’t improved—in fact, it’s gotten worse. We’re going out of our minds with worry. We heard an expert was seeing patients today, so we made an appointment with you. We were hoping you could take a look."
Li Xu’s brow furrowed slightly after he heard their story.
This wasn’t exactly standard procedure. The patient was still in the inpatient department, and as an outpatient clinic doctor, he shouldn’t be directly interfering with treatment there.
But seeing the desperate looks on the couple’s faces, he knew they were at their wit’s end.
He thought for a moment before saying to the couple, "How about this? Let me see your son’s medical records first."
"Here."
The husband quickly handed them over.
Li Xu took the file and examined it carefully.
The patient’s name was Xiao Bao. He was a three-year-old boy.
The medical records clearly documented the progression of the boy’s illness:
The fever started last night and hadn’t broken by this morning. His condition only grew more severe, which was when the couple rushed him to the hospital.
Li Xu continued reading the information from the admission records.
The admission examination showed the little boy had average development and nutrition, with a body temperature as high as 39.7 degrees Celsius.
The physical exam revealed dullness in the lower posterior left lung, diminished breath sounds, and wheezing throughout both lungs, accompanied by scattered medium and fine rales. His heart rate was high, at 165-175 beats per minute, and his liver was palpable 4 centimeters below the right costal margin.
Since the little boy was uncooperative, a neurological reflex examination could not be performed.
The rest was blood work information. The data for his white blood cells, neutrophils, and lymphocytes were all abnormal.
The patient’s fever began last night, and by today he was wheezing, agitated, and having difficulty breathing. His face had turned blueish, and he was no longer fully conscious, constantly mumbling incoherently. His breathing was rapid and shallow, causing his nostrils to flare quickly.
From a Western medicine perspective, upon admission, he was immediately given oxygen inhalation and an intramuscular injection of digitoxin, along with streptomycin for anti-infective therapy.
However, the treatment was not having the desired effect. The boy’s condition showed no signs of improvement.
The attending physician, Lin Guorui, had just performed bloodletting on the patient’s Shixuan acupoints, but that didn’t seem to have any noticeable effect either. This was the sum of all diagnostic and treatment information so far.
Just by looking at these documents, Li Xu couldn’t fully determine the child’s specific condition.
He decided to go to the inpatient department himself to see the patient.
If it had been any other doctor, Li Xu might have hesitated, as interfering with another physician’s treatment is quite rude.
But luckily, he was very familiar with Lin Guorui, and knew Lin Guorui wouldn’t mind.
Li Xu motioned to the anxious couple and said to Tang Changchun, "Dr. Tang, come with me to the inpatient department to see the patient."
Tang Changchun immediately replied, "Yes, Dr. Li."
The three of them hurried toward the inpatient department.
When they arrived at the hospital room, Lin Guorui was anxiously observing the child by the bedside.
His face showed surprise when he saw Li Xu walk in with the patient’s parents.
"Dr. Li, what are you doing here?"
Lin Guorui asked.
The patient’s father quickly stepped forward to explain. "Dr. Lin, we heard that Expert Li was seeing patients today, so we specifically asked him to come take a look at our son."
After hearing this, Lin Guorui was pleasantly surprised.
He had been worrying about the child’s condition. Li Xu’s arrival was a godsend.
He quickly stepped aside and said cheerfully, "Dr. Li, this is wonderful! Please, diagnose the child. I’m at a loss for what medicine to use."
Hu Qiming, who was standing to the side, also greeted Li Xu.
He was already studying under Lin Guorui.
Li Xu walked to the bedside and leaned over to examine the child.
The little boy was feverish and agitated, constantly muttering nonsense. He looked restless, his breathing was labored, rapid, and shallow. His face was flushed, and his forehead was beaded with fine sweat.
But the rest of his body was sweat-free, his skin dry and burning hot.
Li Xu gently pressed the child’s abdomen. It was full but not solid, with a vague feeling of distention.
He opened the child’s mouth to observe his tongue. The tongue coating was white, greasy, and slightly yellow, while the tongue itself was red.
Finally, he extended his fingers and placed them on the child’s wrist to take his pulse.
The child’s pulse was floating and rapid.
Li Xu withdrew his hand and fell into thought.
’A floating pulse indicates an exterior pattern, a disease residing in the Fu-organs.’
’Forceful indicates wind; weak indicates blood deficiency.’
’A floating pulse can indicate wind-heat.’
The *Treatise on Cold Pathogenic and Warm Pathogenic Diseases* also clearly states: "When the pulse is floating and rapid, the proper method is to induce sweating for recovery. If purgation is used instead, and the body feels heavy with palpitations, one must not induce sweating; sweating should occur naturally to resolve the condition."
A major principle of TCM treatment is that regardless of the situation, as long as an exterior pattern is present, one must always resolve the exterior first. All other symptoms must wait until the exterior pattern is resolved.
Any other mistaken attacks, tonification, or purgation could very well lead to a worsening of the condition, and could even be life-threatening.
However, Li Xu’s brow furrowed.
He then recalled another line from the *Treatise on Cold Pathogenic and Warm Pathogenic Diseases*: "When the pulse is floating and rapid, one can induce sweating. Ephedra Decoction is suitable..."
’But this patient... seems a little different.’
The child was deliriously agitated with a high fever. It would seem that a method using bitter and cold herbs to clear heat and detoxify would be appropriate. But his exterior pattern was unresolved. If bitter-cold medicine were truly used now, it would likely cause an immediate negative turn. Especially since he had severe pneumonia and was in critical condition, using the wrong medicine would have unimaginable consequences. It would probably trigger a disaster right away.
Li Xu turned his head to Tang Changchun and asked, "Dr. Tang, take a look. What are your thoughts on this patient?"
Tang Changchun was a top student with a strong theoretical foundation, and he had also analyzed some aspects of the situation.
He contemplated for a moment and said, "Dr. Li, the patient’s pulse is floating and rapid, indicating an unresolved exterior pattern. The *Treatise on Cold Pathogenic and Warm Pathogenic Diseases* once said: ’In Taiyang disease, the pulse is floating, stirring, and rapid; floating indicates wind, rapid indicates heat, stirring indicates pain, and rapid can also indicate deficiency. If there is headache, fever, slight night sweats, and an aversion to cold, the exterior is unresolved.’ But using Ephedra Decoction... that doesn’t seem quite right either. The child’s symptoms aren’t purely a wind-cold pattern."
"The patient’s pulse is floating and rapid, which suggests a wind-heat pattern. The child clearly has constrained lung qi, which is why his breathing is so labored and rapid. Also, there’s high fever without sweating, except for some slight sweat on his forehead. In reality, there is internal heat and external cold, and the lung qi is constrained, leading to such a severe condition."
After finishing his analysis, Tang Changchun looked somewhat puzzled. "But I don’t understand why he got sick like this."
Li Xu didn’t rush to give his own diagnosis. Instead, he called the child’s parents over and asked for a detailed account of how the illness began.
The child’s mother said anxiously, "Dr. Li, my son got sick yesterday on the train. We were traveling from the south, it was a long journey, and the train car was stuffy and hot. My son first broke out in a sweat, and then he was exposed to the cold air from the air conditioner and caught a bit of a chill. After we got home, he started running a fever, and it just kept getting worse..."
After listening, Li Xu nodded thoughtfully and said, "It’s similar to winter-warmth."
Upon hearing the words "winter-warmth," Tang Changchun immediately chimed in, "So, a solution from the Warm Disease School?"
